Provider Demographics
NPI:1275751323
Name:MERRITT, GINA MARIE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MARIE
Last Name:MERRITT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:11304 EDGEWATER DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-8499
Mailing Address - Country:US
Mailing Address - Phone:616-892-1070
Mailing Address - Fax:
Practice Address - Street 1:11304 EDGEWATER DR
Practice Address - Street 2:SUITE D
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-8499
Practice Address - Country:US
Practice Address - Phone:616-892-1070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801085401101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1712452Medicaid
MI750910903Medicare UPIN
MI1712452Medicaid
MI20378Medicare UPIN